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cholesterol
Contents
About this booklet ......................................................................... 4
What are blood lipids, and what is cholesterol?.................. 5
How are blood cholesterol and triglycerides measured?.. 9
What part does cholesterol play
in coronary heart disease? ........................................................ 11
What causes high blood cholesterol?................................... 14
How can physical activity help
improve my cholesterol level? ................................................ 15
How can healthy eating help improve
my cholesterol level? .................................................................. 16
Will I need to take medicine? .................................................. 29
How can medicine help? ........................................................... 31
Familial hypercholesterolaemia (FH) .................................... 38
How your support can help ..................................................... 40
For more information ................................................................. 41
Index ................................................................................................. 45
Have your say ................................................................................ 47
Cholesterol
Cholesterol is a waxy substance which is mainly made in
the body. The liver makes some of the cholesterol from
the saturated fats in the foods you eat. (We explain more
about which foods contain saturated fats on page 18.)
Certain foods also contain some cholesterol (see
page 21).
Cholesterol plays a vital role in how every cell works,
throughout the body. It is also the material which the
body uses to make other vital chemicals. However,
having too much cholesterol in the blood can increase
your risk of getting heart and circulatory disease. (Heart
and circulatory disease includes coronary heart disease,
stroke, and diseases that affect the circulation such
as peripheral arterial disease. We explain more about
coronary heart disease on page 11.)
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Triglycerides
Triglycerides are another type of fatty substance in the
blood. They are found in foods such as dairy products,
meat and cooking oils. They can also be produced in the
body, either by the bodys fat stores or in the liver. People
who are very overweight, eat a lot of fatty and sugary
foods, or drink too much alcohol are more likely to have a
high triglyceride level.
Blood lipids
Blood lipids include cholesterol and triglycerides.
Some types are bad, but one type (HDL cholesterol)
is good.
Cholesterol
LDL cholesterol bad
HDL cholesterol good
Triglycerides bad
Total cholesterol
Your total cholesterol level is the total of the LDL, HDL
and other fats in your blood.
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10
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smoking
having high blood pressure
not being physically active enough
being overweight or obese
having diabetes
being of South Asian origin, and
having a family history of premature coronary heart
disease. (This means if a close blood relative of yours
developed coronary heart disease before the age of 55
for a man, or 65 for a woman.)
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Which foods
are these fats
found in?
Monounsaturated
fats
Polyunsaturated
fats
Ome
Found in:
olive oil and
rapeseed oil
avocado
nuts and seeds
(almonds,
cashews,
hazelnuts,
peanuts and
pistachios).
Found in:
corn oil, sunflower
oil and soya oil
nuts and seeds
(walnuts, pine nuts,
sesame seeds and
sunflower seeds),
and
oily fish such as
herring, mackerel,
pilchards, sardines,
salmon, trout and
fresh tuna.
Foun
Some spreads
are made from
monounsaturated
fats.
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Some spreads
are made from
polyunsaturated fats.
d fats
er
uts,
d
,
l,
es,
d
ats.
Saturated fats
Omega-3 fats
Saturated fats
Trans fats
Found in:
butter
hard cheese
whole milk
fatty meat
meat products
biscuits
cakes
cream
lard
dripping
suet
ghee
coconut oil
palm oil
pastry.
Found in:
pastries
cakes
biscuits
crackers
fried foods
takeaways
hard margarines.
Foods that have
hydrogenated oils
or fats or partially
hydrogenated oils
or fats in the list
of ingredients are
likely to contain
trans fats.
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Peters story
Peter Dowse, 64, explains what he did after he was told
he had high cholesterol levels.
When I was told l had raised cholesterol levels, l
instantly visualised clogged-up arteries. A major
change to my lifestyle was needed, and instead of
starting on medication, l decided to adjust my lifestyle.
My GP emphasised that l would need to have regular
cholesterol checks in case I needed to take cholesterol
tablets in the future.
The change started with introducing regular exercise,
so I took up running. The first few times were
challenging, but with perseverance it got better. My
diet had to change too. l became more conscious of
what l ate and checked food labels when shopping.
As a family we started eating healthier and more
balanced meals, more vegetables and less food high in
saturated fats. I also limited alcohol to weekends.
18 months on Im a better runner, have maintained a
healthy diet and lost over 3 stones. Most importantly,
my cholesterol levels are now within normal limits. My
wife says its like having a new man.
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salt a day thats about one level teaspoon. Try not to add
salt to your food. Use extra pepper, herbs, garlic or spices
to add flavour to your food instead. Choosing more fresh
foods rather than ready meals or processed foods will also
help you cut down on salt.
Salt substitutes may not be suitable for some people for
example, those with kidney problems or heart failure. So
check with your doctor before using these products.
For more information, see our booklets Blood pressure or
Cut down on salt.
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Your health is
athighrisk if you
have a waist size of:
Men
Women
South
Asian men
Over 90 centimetres
(about 35 inches)
South
Asian
women
Over 80 centimetres
(about 311/2 inches)
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Your doctor will choose the best statin and dose for
you, depending on your medical history and your target
cholesterol level. He or she may change your statin if it does
not help to lower your cholesterol level as much as it needs
to. However, if your doctor is planning to change your statin,
you should have a blood cholesterol test and liver function
tests before and after the change. This will help to make
sure that the new medicine works well for you.
Statins are not suitable for people who have liver disease
or for women who are pregnant or breastfeeding. If youre
already taking statins and are thinking of starting a family,
you should speak to your doctor before stopping your
medicines.
Some statins should be taken in the evening, because our
bodies make most of our cholesterol overnight, when we
are usually asleep.
If you are taking a statin called simvastatin, you should
avoid drinking grapefruit juice or eating grapefruit.
However, if youre taking another type of statin, you may
be able to have small quantities of grapefruit juice (or
grapefruit). If you have any questions about statins and
grapefruit, talk to your doctor or pharmacist.
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Over-the-counter statins
These are statins that people can buy from their local
pharmacists without a prescription from a doctor.
They are not a substitute for adjusting your lifestyle
to reduce your cholesterol, and they are not suitable
for everyone. Your pharmacist will be able to tell you
whether these medicines are suitable for you. Before
giving you any advice, he or she will ask you about your
risk factors for heart disease such as whether you
smoke, or have high blood pressure. They will also tell
you if you need to have regular blood tests to check
that your liver and kidneys are working properly.
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fibrates
medicines which bind bile acids, and
ezetimibe.
These medicines may be prescribed by a specialist, either
if statins dont work for you, or if you cant take them for
some reason.
Many of these medicines act by preventing the intestine
from absorbing cholesterol. This in turn prevents
cholesterol entering the bloodstream and raising blood
cholesterol levels.
Fibrates
Fibrates are useful for people who have a high level of
triglycerides. They may also be used with other medicines
to lower your cholesterol if you cannot take statins.
You will not usually be given fibrates if you are also
taking statins (see page 31), except under strict medical
supervision. You should not use fibrates during pregnancy,
or if you have liver or kidney disease.
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Ezetimibe
Ezetimibe is another type of cholesterol-lowering
medicine. It can be used along with a statin. Or, people
who cant take statins can take ezetimibe on its own.
Ezetimibe helps to lower blood cholesterol levels by
preventing the small intestine from absorbing cholesterol.
Ezetimibe can help reduce LDL cholesterol by about 20%,
and if it is combined with low-dose statins it can be even
more effective. More research is needed to confirm the
long-term benefits of this medicine.
Possible side effects
Side effects of ezetimibe include headaches, pain in the
abdomen, and diarrhoea.
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bhf.org.uk
For up-to-date information on heart disease, the BHF
and its services.
Heart Helpline
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Our services
For more information about any of our services, contact
the Heart Helpline on 0300 330 3311 or visit bhf.org.uk
Heart Matters
Heart Matters is the BHFs free, personalised service that
provides support and information for people who want
to improve their heart health. Join today and enjoy the
benefits, including heart matters magazine and an online
members area. Call the Heart Helpline on 0300 330 3311,
or join online at bhf.org.uk/heartmatters
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Index
activity ............................................................................................................15
bile-acid-binding medicines .................................................................35
blood pressure ...........................................................................................13
causes of high blood cholesterol .........................................................14
children .........................................................................................................38
cholesterol ..................................................................................................... 5
in foods ..................................................................................................21
measurement of ................................................................................... 9
targets ............................................................................................... 9, 10
coronary heart disease ........................................................................ 8, 11
diet ..................................................................................................................16
eggs ................................................................................................................21
ezetimibe .....................................................................................................36
familial hypercholesterolaemia ............................................................38
fats ..................................................................................................................16
FH ...................................................................................................................38
fibrates ..........................................................................................................34
fibre .................................................................................................................21
fish oil supplements .................................................................................37
HDL ........................................................................................................6, 9, 10
healthy eating ............................................................................................16
LDL .........................................................................................................6, 9, 10
lipids ................................................................................................................. 5
medicines ..............................................................................................29, 31
monounsaturated fats ...............................................................16, 18, 20
oily fish ..........................................................................................................25
omega-3 fats ........................................................................................19, 20
over-the-counter statins .........................................................................33
Reducing your blood cholesterol
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Acknowledgements
The British Heart Foundation would like to thank all the
GPs, cardiologists, nurses and other health professionals
who helped to develop the booklets in the Heart
Information Series, and all the patients who commented
on the text and design.
Particular thanks for her work on this booklet are due to:
Clare Neuwirth, Lipid Specialist Nurse, Imperial College
Healthcare NHS Trust.
British Heart Foundation 2014, registered charity in England and Wales (225971) and in Scotland (SCO39426) HIS03/0114